scholarly journals Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) for detecting clinically important cervical spine injury following blunt trauma

2018 ◽  
Author(s):  
Bruno T Saragiotto ◽  
Christopher G Maher ◽  
Chung-Wei Christine Lin ◽  
Arianne P Verhagen ◽  
Stacy Goergen ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Blunt Trauma ◽  
Cervical Spine Injury ◽  
Spine Injury ◽  
National Emergency

DETECTION OF PEDIATRIC CERVICAL SPINE INJURY

Neurosurgery ◽  
2008 ◽  
Vol 62 (3) ◽  
pp. 700-708 ◽  
Author(s):  
Hugh J.L. Garton ◽  
Matthew R. Hammer
Keyword(s):  
Cervical Spine ◽  
Young Children ◽  
Cervical Spine Injury ◽  
Diagnostic Yield ◽  
Plain Film ◽  
Spine Injury ◽  
Lower Sensitivity ◽  
X Rays ◽  
Flexion Extension ◽  
National Emergency

Abstract OBJECTIVE In evaluating the pediatric cervical spine for injury, the use of adult protocols without sufficient sensitivity to pediatric injury patterns may lead to excessive radiation doses. Data on injury location and means of detection can inform pediatric-specific guideline development. METHODS We retrospectively identified pediatric patients with codes from the International Classification of Diseases, 9th Revision, for cervical spine injury treated between 1980 and 2000. Collected data included physical findings, radiographic means of detection, and location of injury. Sensitivity of plain x-rays and diagnostic yield from additional radiographic studies were calculated. RESULTS Of 239 patients, 190 had true injuries and adequate medical records; of these, 187 had adequate radiology records. Patients without radiographic abnormality were excluded. In 34 children younger than 8 years, National Emergency X-Radiography Utilization Study criteria missed two injuries (sensitivity, 94%), with 76% of injuries occurring from occiput–C2. In 158 children older than 8 years, National Emergency X-Radiography Utilization Study criteria identified all injured patients (sensitivity, 100%), with 25% of injuries occurring from occiput–C2. For children younger than 8 years, plain-film sensitivity was 75% and combination plain-film/occiput–C3 computed tomographic scan had a sensitivity of 94%, whereas combination plain-film and flexion-extension views had 81% sensitivity. In patients older than 8 years, the sensitivities were 93%, 97%, and 94%, respectively. CONCLUSION Younger children tend to have more rostral (occiput–C2) injuries compared with older children. The National Emergency X-Radiography Utilization Study protocol may have lower sensitivity in young children than in adults. Limited computed tomography from occiput–C3 may increase diagnostic yield appreciably in young children compared with flexion-extension views. Further prospective studies, especially of young children, are needed to develop reliable pediatric protocols.

Prehospital Factors Associated With Cervical Spine Injury in Pediatric Blunt Trauma Patients

2020 ◽  
Author(s):  
Lorin R. Browne ◽  
Fahd A. Ahmad ◽  
Hamilton Schwartz ◽  
Michael Wallendorf ◽  
Nathan Kuppermann ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Blunt Trauma ◽  
Cervical Spine Injury ◽  
Spine Injury ◽  
Trauma Patients ◽  
Factors Associated

Cervical spine injury in low-impact blunt trauma

1999 ◽  
Vol 17 (2) ◽  
pp. 125-129 ◽  
Author(s):  
Raymond J Roberge ◽  
John R Samuels
Keyword(s):  
Cervical Spine ◽  
Blunt Trauma ◽  
Cervical Spine Injury ◽  
Spine Injury

Detection of Cervical Spine Injuries in Alert, Asymptomatic Geriatric Blunt Trauma Patients: Who Benefits from Radiologic Imaging?

2006 ◽  
Vol 72 (9) ◽  
pp. 773-777 ◽  
Author(s):  
Adrian W. Ong ◽  
Aurelio Rodriguez ◽  
Robert Kelly ◽  
Vicente Cortes ◽  
Jack Protetch ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cervical Spine ◽  
Blunt Trauma ◽  
Cervical Spine Injury ◽  
Motor Vehicle ◽  
Spine Injury ◽  
Trauma Patients ◽  
Cervical Spine Injuries ◽  
Spine Injuries ◽  
Anatomic Locations

There are differing recommendations in the literature regarding cervical spine imaging in alert, asymptomatic geriatric patients. Previous studies also have not used computed tomography routinely. Given that cervical radiographs may miss up to 60 per cent of fractures, the incidence of cervical spine injuries in this population and its implications for clinical management are unclear. We conducted a retrospective study of blunt trauma patients 65 years and older who were alert, asymptomatic, hemodynamically stable, and had normal neurologic examinations. For inclusion, patients were required to have undergone computed tomography and plain radiographs. The presence and anatomic location of potentially distracting injuries or pain were recorded. Two hundred seventy-four patients were included, with a mean age of 76 ± 10 years. The main mechanisms of injury were falls (51%) and motor vehicle crashes (41%). Nine of 274 (3%) patients had cervical spine injuries. The presence of potentially distracting injuries above the clavicles was associated with cervical injury when compared with patients with distracting injuries in other anatomic locations or no distracting injuries (8/115 vs 1/159, P = 0.03). There was no association of cervical spine injury with age greater or less than 75 years or with mechanism of injury. The overall incidence of cervical spine injury in the alert, asymptomatic geriatric population is low. The risk is increased with a potentially distracting injury above the clavicles. Patients with distracting injuries in other anatomic locations or no distracting injuries may not need routine cervical imaging.

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